HomeMy WebLinkAboutMortgage_Campbell (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709IR71 / 6-09)
� PmsaibeE by DeparlmeM of Loral Govemment Firexe
�srRUCnoNS:
b 6e fiied in person a by mail wiN the CounlyAutlitor or Counry Recorder of the county where Ihe property is located.
5Ti Dates: 1 RealPro � � ZO'�
ng ) perty: Musf file durirg Ne year for which the deduclion is sought. unty Au itor
2) Mobde / Manufactured Homes rrot assessed as Real Proper(y.' Must fife dunng the tweNe (12) months r1—�
before March 31 of each year the deduction is soughf. �7=y� er
�i�rd
�`
See reverse side (or addifional instructions and oualifrcations. . �
—/A—UJ-�
Asecsed We dmal pmperty as N Fbrtgage / Contraa u
Mart�h 7, neient ymr IA2rtl� 1. artent year
If no, what is ha / tcer exad share ot interesi?
If name on R�dd i5 Nfierpm Ihan Nai of appGrant uldipte Eebw'
Name of mortgagee or mntraU seller /7 _/ �
Mtlress d rtnrtgayce ar mntrad se0er (nuniber aM sL
Name ot asvgnee p dhc owner or holtler of rtqrtgage
Mtlress ot assignee (number aM sbee4 �y. slate, ara
crty, stare, aM
�UU�
ess unpaid as Mortgage
date ot a
�f owned wiN sonu
, 3-
rwnorl
kgal a epuilable ownM
% �. � ❑ Yes ❑ No
sp�o�tt . IMkate wM wMrn
Is the property in purstion: Mnualy Assessed
�'aeai �oaenv ❑ i4muaiy asussea
_l ooes applirant own property in any otl�er IF yes. wliat counry? I lM�a� Tap�g Distnct? ( Has Iha CetlucUm Geen mquesteE m Properry
' — _ __ _ .— _ — ___ forcurrentynaR
❑ Yes ❑ N�
� Dl:ll1'G� NO...D�.l.,/(,I...... COUNTYAUDROR
C:il�(� �Q. ..tY.�V�........ — 20_ 20 20_ 20_
lO�l � I l!J• (!O Counry Date (monfh, day.Yea�
I/ We cerGfy under the penalry of pe�ury that the above and (oregoing informalion is We aM cortect and Nat Ne applicant is a resident of Irdiaria and
owner / wnVacl buyer of the a(orementioned property on date appliration is filed.
�I( FWlr�sidenl`addf�si"6t3pbTiialh numberandstreeTa'lfi,Slati
/� � - ` ��� �1 .�
/ Pe�son au o�rz by ezecutetl Power dAttomeY a q' IC
fWemss W autha'¢ed person (number aM snee4 �ry. s+ate. a
(monN. OaY. yEar)